Concurrent audit: controlling hospital stays while they happen.
We follow inpatient care to verify appropriateness, control length of stay and detect risks before they become claim objections or costs. More than 30 years of experience, backed by PA Global Network.
A Forum of Firms network
Act during care, not afterwards.
Concurrent audit reviews hospitalization while it is under way: it checks that procedures, medicines and length of stay are appropriate, and alerts the insurer or provider when something falls outside what is expected.
When you need it
- A health insurerwants to control hospitalization costs in its network.
- A providerneeds to reduce objections for appropriateness and long stays.
- High-cost patientsrequire close follow-up.
- Adverse eventsare being detected too late.
What we follow in each hospital stay.
We review the clinical record and talk to the treating team at each visit.
Appropriateness of admission
That the hospitalization is justified by the diagnosis.
Length of stay
Days of stay against what is expected for each diagnosis.
Procedures
Appropriateness of surgery, diagnostic tests and consultations.
Medicines
Appropriate use of medicines, especially high-cost ones.
Adverse events
Detection and reporting of events that affect patient safety.
Discharge
Discharge planning and prevention of readmissions.
Visits, clinical records and alerts.
Healthcare professionals visit network facilities as often as the contract requires.
- 1Daily censusWe receive the inpatient census and prioritize cases.Hospital census
- 2Visit and reviewWe review the clinical record and talk to the treating team.Clinical practice guidelines
- 3AlertsWe report deviations in appropriateness, stay or cost immediately.Early alerts
- 4Periodic reportConsolidated indicators by facility and recommendations.Quality indicators
Information to decide in time.
- Early alerts on appropriateness, length of stay and cost.
- Periodic reports by facility and diagnosis.
- Indicators of length of stay, readmissions and adverse events.
- Support for the subsequent medical claims audit.
What you should know.
What is a concurrent audit?
It is the follow-up of inpatient care while it happens, to verify appropriateness and quality and to control cost.
Who performs it?
Physician and nurse auditors, who visit facilities and review clinical records.
How often are patients visited?
The contract sets the frequency based on volume and risk; high-cost patients are usually followed more closely.
Does it reduce claim objections?
Yes. By reviewing appropriateness during care, many later objections to invoices are avoided.
Is patient confidentiality respected?
Yes. Access to clinical records is limited to authorized professionals and handled in confidence.
Services that work together.
Do you want to control hospital stays in real time?
Tell us the size of your network and a partner will send you a proposal.
Auditoría Concurrente
icon
http://www.auditoriaygestion.co/wp-content/uploads/2015/03/auditoria-concurrente.jpg
fadeIn
In the practice of Concurrent Audit we conducted a systematic, continuous and comprehensive evaluation of the quality of medical care , taking into account the effective and proper use of the services and the final result obtained by the patient in the institution and the services provided also what is billed , actually corresponds to the appropriate coverage, according to current regulations, analyzing user satisfaction and evaluating the quality of service of the medical record.
Preguntas? Escríbenos al instante en WhatsApp!